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Asking the Right Questions: The Road to Definitive Diagnosis

As the thousands of radiologists gathering this week at RSNA will tell you, diagnosis isn’t easy. It’s often a painful, tedious and fraught process for patients and their families. Clinicians are rightfully anxious about acting quickly and getting answers so they can move patients into the right course of treatment. Then add in the complication of radiation dose management, a very important issue that patients are concerned about, and clinicians are required to manage. As the technology becomes even more advanced, imaging options available to health systems continue to expand.

Yet, as the role of radiology in the health continuum becomes even more critical, it’s not enough to hope to achieve “early” or even “accurate” diagnosis. Someone can give you directions that may be easy to follow and accurate in that they eventually get you to where you need to go. But those directions could include one too many turns, and bring to you to your destination through an uncomfortable, indirect, and expensive path that caused some confusion and potential swearing at your steering wheel in the process. What the industry is in a place to demand, and where we have the data to make it happen, is definitive diagnosis.

Definitive diagnosis means putting patients down the shortest path to the best care at lowest ultimate cost. And sometimes that means starting in a very different place than where the industry is currently comfortable. Today, a patient with a knee injury will likely start his or her diagnostic journey by seeing a physician who will probably recommend an X-ray. As the laws of health system reimbursement dictate, clinicians start at the bottom and work their way up the imaging food chain. So they don’t begin with the most expensive or even more detailed scan, like a MRI or a CT.

But at the end of the day, the MRI scan may have been the right place to start, and if we had, we could have ultimately reduced cost by skipping the tests and other unnecessary costs that didn’t yield the right result, to enter patients into a faster path to treatment, recovery, and wellness. It’s like directions that send you driving through a cul-de-sac, only to really have to take a left at the next intersection. To get it right, we need to look longitudinally at both cost and quality of care not in silos, but across the whole journey. We will see a future where integrated clinical solutions will provide seamless information and “holistic” patient profiles to assist Radiologists.

How do we change the industry’s mindset, so that we can take those unnecessary costs, and added lefts and rights, out of the system? It starts by asking the right questions, derived by having the right data. Today, radiologists are no longer confined by the walls of radiology. Pathology and radiology are moving closer together. With informatics, EMR, genomic, molecular imaging and a confluence of other data at their fingertips, radiologists can consider so many of the other factors that come into play when diagnosing someone.

This means that the question is not “When can we do an MR?” or even “What test should we order?” but more like “What other information do I need to order the right test for this patient?” or “What patterns can I detect about this patient?” and “How is this patient like others I’ve seen in different data sets?”

In this way, radiology is set for a revolution. It is already becoming a broader based diagnostic specialty –“diagnosticians,” I like to think – who collaborate across teams supported by better data. Like anything in health care, we need not only the progressive radiologists, but the cost and quality research to support this shift. Studies like this have shown that cancer patients evaluated with PET scans can know within a week whether chemotherapy is working – as compared to the traditional wait and see approach.

These rapid prototypes of new courses of care that may start with a more expensive test will enable the industry to consider cost and quality of care along the axis of the patient’s whole journey. These are the questions we should be asking that will make definitive diagnosis even more achievable than it is today.

The focus of the next five to ten years in health care will be liberating costs while improving quality. With that in mind, the role of radiology sits at a critical intersection. With the right data enabling them to ask the right questions, and the technology to connect and collaborate across the health continuum, radiologists will be in a position to play an even more critical role in putting patients on the right care path at the lowest cost.

Gene Saragnese

CEO, Imaging Systems

Gene joined Philips Healthcare as Executive Vice President and CEO of Philips Imaging Systems in April 2009. He also serves as a member of Philips Healthcare’s Executive Team.